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1265700884
FERNANDO JOSE PENA
PORTLAND, OR
NPI
1265700884
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 14-11-18)
Enumeration Date
2011-12-09
Last Update Date
2016-07-27
Business Address
-- FERNANDO JOSE PENA CADC II
10209 SE DIVISION ST BLDG D
PORTLAND, OR 97266-1372
Phone number: 503-716-0481
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Mailing Address
-- FERNANDO JOSE PENA CADC II
PO BOX 16756
PORTLAND, OR 97292-0756
Phone number: 503-593-2129
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